I  was fortunate to serve as the principal investigator of a major study that looked into why African American women, regardless of their socioeconomic background, are more likely to have babies born pre-term and with low birth weight.

The data suggest that black women’s stress levels are higher than their white counterparts, and that stress is tied into issues of race and gender.

“If we look at the nurturing role many women assume, the added burden of racism means that there is a concern about children having to be confronted with racism.”

“Racial profiling is a concern for African-American mothers well before their children are born. If women knew they were going to have a male child, there was real concern about how they would protect them. It’s a major thing.”

--Fleda Mask Jackson, Ph.D, as quoted in the "Emory Report" 

 
Selected Publications

Jackson, Fleda M, James, Sherman A, Owens, Tracy C, Bryant Alpha F (2018). Anticipated Negative Police-Youth Encounters and Depressive Symptoms among  Pregnant African American Women: A Brief Report. J Urban Health. DOI 10.1007/s11524-017-0136-3

The widely publicized violent encounters between police and African American youth have unknown consequences for the emotional and mental health of pregnant African American women. Since studies document the hypervigilance black mothers exert to protect children from violence and racism and findings also reveal the association between racial and gendered stress (which includes parenting stressors) and depressive symptoms during pregnancy, an examination of the effects of stress from anticipated negative experiences between black youth and police on maternal mental health is warranted. 

100 mostly low income pregnant African American women living in metropolitan Atlanta were administered the Edinburgh postnatal depression scale and the Jackson, Hogue, Phillips Contextualized Stress Measure (JHP). The results from analysis of a question from the JHP measure, the Edinburgh tool, and the demographic covariants revealed that the anticipation of future negative police-youth encounters was significantly associated with antenatal depressive symptoms and that the presence of male child under the age of five living in the home was also significantly associated with antenatal depression.

The results from this study have important implications for clinical and community-based interventions for addressing the unique psychosoial risks for pregnant African American women.

 Jackson, Fleda M, Saran, Ama, Ricks, Sharon, Essien, Joyce, Klein, Kevin, Roberts, Darryl, Worthy,Natasha (2014). Save 100 Babies(c): Engaging Communities for Just and Equitable Birth Outcomes through Photovoice and Appreciative Inquiry. Matern Child Health J. DOI 10.1007/s 10885-014-1436-9.

This paper presents a community engagement model designed to advance social justice and health equity for African American birth outcomes through the combined  techniques of Photovoice and Appreciative Inquiry. In response to the persistent racial disparities in birth outcomes, Save 100 Babies© was constructed as a two-day summit where the emphasis was placed on individual and community assets rather than deficits. The engagement was designed to create a level of readiness among individuals working within and outside the field of Maternal and Child Health (MCH) to envision strategies to attain equitable birth outcomes. The goal of the conference was to facilitate higher level consciousness  by guiding the participants though a process aimed at  articulating assets, possibilities and the potential for co-creating the desired future where racial disparities in birth outcome are eliminated. As the result of the guided discourse that began with photographs of the lives of African American women, participants articulated the strengths they detected from the pictures, their recommendations for multifaceted changes in policies and practices, and their individual and organizational commitments for a changed future. Since the summit participants have indicated ways they have fulfilled their vows that include informing families and communities about pregnancy risks, working with youth programs, supporting fatherhood involvement in pregnancy and birth, and advancing case management that is more attuned to women’s strengths. Save 100 Babies© is evolving into a network and clearinghouse for sharing and disseminating information and resources for collaboration.

 

Jackson, Fleda M., Rowley, Diane L., Owens, Tracy C. (2012). Contextualized stress, global stres, and depression in well-educated African American women. Women's Health Issues Journal, 22(3), May-June, e329-e336.

Purpose: Well-educated, pregnant, African-American women are disproportionately at risk for adverse birth outcomes and depression linked to stress has been established as a significant contributor to poor birth outcomes. Since racial and gendered stress has been identified as a threat to birth outcomes, a cross-sectional study was conducted that utilized the Jackson, Hogue, Philiips Contextualized Stress Measure (JHP), a measurement of racial and gendered stress, and the Perceived Stress Scale (PSS), an assessment of of global stress, to detect their associations and predictions for depression as measured by the Beck Depression Inventory II (BDI-II). 

Method: We recriuted 101 pregnant, well-educated, African-American women from ob-gyn offices who were administered the JHP, the PSS, and the BDI-II. Correlational, chi-square, and stepwise regression analyses were conducted with the measures and the demographic variables of relationship status, the presence of other children, and annual household income. 

Findings:The results revealed significant linear and covariate associations for the JHP, PSS, and BDI-II. Correspondingly, chi-square analysis found significant associations for the JHP and BDI-II and the presence of other children, relationship status, and annual household income. Results from the regression models found that the contextualized and global stress measures were both predictive of depression. Demographic characteristics did not predict depression. 

Conclusion: The results argue for prenatal depression and stress screening. Furthermore, the link between contexualized stress and depression alerts care providers and local communities to be responsive to the particular stressors that pose risk for pregnant African American women and their babies.

Jackson, Fleda Mask, Phillips, Mona Taylor, Hogue, Carol J.R., Curry-Owens, Tracy (2001).

Examining the Burdens of Gendered Racism: Implications for the Pregnancy Outcomes of College-Educated African American Women. MCH Journal, 5(2): 95-107.

Objectives: As investigators increasingly identify racism as a risk factor for poor health outcomes (with implications for adverse birth outcomes), research efforts must explore individual experiences with and responses to racism. In this study, our aim was to determine how African American college-educated women experience racism that is linked to their identities and roles as African American women (gendered racism).

Methods: Four hundred seventy-four (474) African American women collaborated in an iterative research process that included focus groups, interviews, and the administration of a pilot stress instrument developed from the qualitative data. Analysis of the qualitative and quantitative data from the responses of a subsample of 167 college-educated women was conducted to determine how the women experienced racism as a stressor. Results: The responses of the women and the results from correlational analysis revealed that a felt sense of obligations for protecting children from racism and the racism that African American women encountered in the workplace were significant stressors. Strong associations were found between pilot scale items where the women acknowledged concerns for their abilities to provide for their children's needs and to the women's specific experiences with racism in the workplace (r = 0.408, p < .001).

Conclusions: We hypothesize that the stressors of gendered racism that precede and accompany pregnancy may be risk factors for adverse birth outcomes. Keywords: stress - racism - reproductive health - pregnancy outcomes - gendered racism - African American women

Jackson, Fleda Mask, Hogue, Carol Rowland, Phillips, Mona Taylor. (October 2005) The Development of a Race and Gender-Specific Stress Measure for African American Women: The Jackson, Hogue, Phillips Contextualized Stress Measure. Ethnicity and Disease, 15(4): 594-600.

Objective: Community-based research was conducted to develop an identity stress measure for African-American women. The aim of the investigation was to capture the voices of African-American women telling their experiences of stress and support and to have their voices inform the development of an identity stress measure representing the realities of being Black and female. In this paper, we describe the components of a race and gender-specific stress measure emerging from a multidisciplinary iterative process that employed qualitative and quantitative methods.

Method: The research was initiated by focus groups and interviews where women were asked to share their experiences of stress and support. Four hundred seventy-four (474) African-American women from the metropolitan Atlanta area collaborated in the study by participating in one or more phases of the research. Content analysis of the qualitative data informed the development of a 71-item race and gender-specific stress measure for African-American women. The scale and a battery of validity measures (Spielburger Anger and Anxiety, John Henryism, and NHIS-depression) were administered twice over a 30-day period followed by group discussions and interviews.

Results: Content and factor analysis resulted in the development of six subscales: racism, burden, personal history, work, support/coping, and stress states. The measure has been validated with established measures of anger, anxiety, depression. Significant correlations were established for all of the stress subscales and measures of anger (trait anger, anger-in, anger-out, and anger expression). Findings indicate significant correlations for the burden subscale and anger-in (r = .33, <.01) and stress states and trait anxiety (r = .57, <.01). Ethn Dis. 2005;15:594–600)